This book investigates actions that families, communities, and civic authorities took to address mental illness in Florence and its Tuscan dominions from the mid-fourteenth century to the mid-seventeenth century. Mellyn pays careful attention to change as Florence went from republic to duchy. She assumes that madness is universal in human history, that madness is at once biological and social, and that, because it is partly social, it is a useful category of historical analysis.

In five chapters, an introduction, and conclusion, the author analyzes the nearly 300 cases of men and women from all social levels who appear in civil and criminal court records during her period. Many cases of insanity did not reach the courts, evidence for that idea being that many more insane men appear in the records than insane women, probably because insanity in men was more destructive of family patrimony. On the other hand, the number of petitioners asking the courts’ help was about equal among women and men.

Mellyn finds that the mad were deeply embedded in society, not outsiders, with the family the basic center of care. The sources show collaboration between petitioners and courts in both republic and duchy, with most petitioners having the interest of the insane persons at heart and a few wanting to exploit them. She disagrees with the negative approach of Foucault, who sees treatment of the mentally ill as neglectful in the Middle Ages, followed in the early modern era by the development of prison-like mental institutions. In her sources, the disruptive insane received prison sentences, and after the sentence they mostly returned to their families. By the seventeenth century, the ducal government had ambitions to centralize the court system and exercise more social control, but it lacked resources, and negotiation between court and petitioner continued to be the norm, with punishments for the disorderly mentally ill being prison, fines, or forced labor. The first hospital for the insane in Florence had the goal of giving the insane a place to stay when released from prison rather than being a place of confinement, and Mellyn suggests this charitable attitude was not unusual, although her study ends too early to make a firm statement about Tuscan institutionalization.

Chapter 1 deals with the civil courts, especially incapacity and guardianship. Chapter 2 deals with criminal courts and the insanity defense. Chapter 3 emphasizes the impact of economic attitudes. Increasing acceptance of wealth rather than the medieval spiritual disapproval of wealth (exemplified by Saint Francis of Assisi) led to the dominance of what Mellyn calls “patrimonial rationality”: the importance placed on the prudent management of patrimony. It affected treatment of the insane because squandering money was increasingly taken as evidence of madness.

Chapters 4 and 5 discuss madness as illness. By the mid-sixteenth century, understanding of mental illness became more nuanced as courts stopped using the Latin language and Roman law categories. Also, the use of medical vocabulary became more widespread. In Mellyn’s sources, doctors’ testimony had little effect on court decisions, contrary to historians who emphasize that the new medical norms were imposed by physicians from the top down. She found that petitioners were as important as physicians to change. The theory of humors became widely known throughout society, and petitioners couched their requests for help in terms of humors, especially melancholy, whereas the courts were interested not in medical testimony but in how their decisions affected the relevant family and sometimes the republican or ducal treasury. However, the petitioner’s motive was often protecting patrimony, whatever the words used to describe the problem.

Throughout this well-written book, individual case studies, sometimes described with a touch of humor, are used to analyze the treatment of the insane and the decision-making process involved in their care. It deals with developments between the Middle Ages and early modern period in one place and one time, providing a basis for comparison with other places and times, and discusses thoroughly historical controversies about care of the insane. It will be of interest to those wanting to know more about the history of mental illness and also about early modern Italy.